Theresa May urged to boost funding or ration care to head off escalating cash crisis and avoid ‘1990s-style decline’

The body that represents hospitals across England has issued a startling warning that the NHS is close to breaking point because of its escalating cash crisis.

Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says. In an unprecedentedly bleak assessment of the NHS’s own health, NHS Providers, which speaks for hospital trust chairs and chief executives, tells ministers that widespread breaches of performance targets, chronic understaffing and huge overspends by hospitals mean that it is heading back to the visible decline it last experienced in the 1990s.

“Taken together this means the NHS is increasingly failing to do the job it wants to do and the public needs it to do, through no fault of its own,” Chris Hopson, the chief executive of NHS Providers, writes in the Observer.

His intervention comes days before the influential Commons health select committee decides whether to launch a special inquiry into the state of the NHS in England. After months dominated by the Brexit debate, the state of the NHS is now emerging as the key domestic challenge facing Theresa May’s government.

Recalling the NHS’s deterioration in the 1990s, which caused political problems for John Major’s government, Hopson adds: “NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect. It’s therefore difficult to isolate a single point in that downward trajectory to sound a warning bell. But NHS trust chairs and chief executives are now ringing that bell. We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate. They are saying it is impossible to provide the right quality of service and meet performance targets on the funding available. Something has to give.”

In a direct appeal to May to increase NHS funding in the autumn statement in November, Hopson warns the government will face “unpalatable choices” if the service is to keep within the existing budget. “The logical areas to examine would be more draconian rationing of access to care, formally relaxing performance targets, shutting services, extending and increasing charges, cutting the priorities the NHS is trying to deliver or, more explicitly, controlling the size of the NHS workforce,” says Hopson.

His warning comes days after the NHS posted its worst set of performance figures for services such as A&E, planned operations and ambulance response times.

Hopson blames the “full-blown crisis in social care” created by cuts to town hall budgets for causing “major problems for the NHS”, such as record numbers of healthy patients who cannot be discharged because social care is not available. This means that “hospitals are now being asked to routinely run at capacity levels that risk patient safety”.
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Theresa May urged to boost funding or ration care to head off escalating cash crisis and avoid ‘1990s-style decline’

The body that represents hospitals across England has issued a startling warning that the NHS is close to breaking point because of its escalating cash crisis.

Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says. In an unprecedentedly bleak assessment of the NHS’s own health, NHS Providers, which speaks for hospital trust chairs and chief executives, tells ministers that widespread breaches of performance targets, chronic understaffing and huge overspends by hospitals mean that it is heading back to the visible decline it last experienced in the 1990s.

“Taken together this means the NHS is increasingly failing to do the job it wants to do and the public needs it to do, through no fault of its own,” Chris Hopson, the chief executive of NHS Providers, writes in the Observer.

His intervention comes days before the influential Commons health select committee decides whether to launch a special inquiry into the state of the NHS in England. After months dominated by the Brexit debate, the state of the NHS is now emerging as the key domestic challenge facing Theresa May’s government.

Recalling the NHS’s deterioration in the 1990s, which caused political problems for John Major’s government, Hopson adds: “NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect. It’s therefore difficult to isolate a single point in that downward trajectory to sound a warning bell. But NHS trust chairs and chief executives are now ringing that bell. We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate. They are saying it is impossible to provide the right quality of service and meet performance targets on the funding available. Something has to give.”

In a direct appeal to May to increase NHS funding in the autumn statement in November, Hopson warns the government will face “unpalatable choices” if the service is to keep within the existing budget. “The logical areas to examine would be more draconian rationing of access to care, formally relaxing performance targets, shutting services, extending and increasing charges, cutting the priorities the NHS is trying to deliver or, more explicitly, controlling the size of the NHS workforce,” says Hopson.

His warning comes days after the NHS posted its worst set of performance figures for services such as A&E, planned operations and ambulance response times.

Hopson blames the “full-blown crisis in social care” created by cuts to town hall budgets for causing “major problems for the NHS”, such as record numbers of healthy patients who cannot be discharged because social care is not available. This means that “hospitals are now being asked to routinely run at capacity levels that risk patient safety”.
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It seems the only way to improve health care is to put the government in charge of it.

The people in Western countries are older and sicker than ever: fat, sedentary and diabetic. The enormous amounts of sugar in the western diet is fueling cancer, heart disease and diabetes. I have read that the average life expectancy in the US is actually declining. All of us in the western world need to get our lives and health in order. The health-care resources in all nations are strapped to the hilt and it’s only getting worse.

The people in Western countries are older and sicker than ever: fat, sedentary and diabetic. The enormous amounts of sugar in the western diet is fueling cancer, heart disease and diabetes. I have read that the average life expectancy in the US is actually declining. All of us in the western world need to get our lives and health in order. The health-care resources in all nations are strapped to the hilt and it’s only getting worse.

The traditional response was to charge such people a higher premium, to compensate for their disease inducing lifestyle. The UK doesn’t have such a feedback mechanism, which also encourages weight loss.

The NHS is always in crisis and always was. Always long waiting lists etc, and sadly here in Ireland is much the same. The INMO issue daily the number of patients waiting beds on trolleys after being admiited in A and E

The people in Western countries are older and sicker than ever: fat, sedentary and diabetic. The enormous amounts of sugar in the western diet is fueling cancer, heart disease and diabetes. I have read that the average life expectancy in the US is actually declining. All of us in the western world need to get our lives and health in order. The health-care resources in all nations are strapped to the hilt and it’s only getting worse.

In this funding crisis, I wish it was that easy, with eating healthier, lowering sugar consumption and the result would be healthier less costly citizens. I mention as there have been a few studies that found lowering sugar levels for costly type 2 diabetics increased the risk of complications and death. It appears possible that the way type 2 diabetes is being addressed is flawed. I thought this a nice article on that problem:

…How well does this work? Some of you will have heard of the ACCORD study, others will not. In this study researchers, tried to force blood sugar levels down as far as possible using intensive treatment. They found the following:

‘Until last week, researchers, doctors and every medical professional has believed for decades that if people with diabetes lowered their blood sugars to normal levels, they could not only prevent the complications from diabetes, but also reduce the risk of dying from heart disease. But the Accord Study, (for Action to Control Cardiovascular Risk in Diabetes), a major NIH study of more than 10,000 older and middle-aged people with type 2 diabetes has found that lowering blood sugar actually increased their risk of death.2’

There is one other way of lowering blood glucose, by using insulin ‘sensitising’ drugs. In diabetes most doctors look at metformin as the wonder drug. This drug improves ‘insulin sensitivity’ i.e. it helps to reduce insulin resistance. It is the absolute mainstay of type 2 diabetes treatment. Once again, however, it is targeted at purely the insulin/glucose model:

‘Metformin has been the mainstay of treatment for type 2 diabetes since 1998 when the UK Prospective Diabetes Study showed reduced mortality with metformin use compared with diet alone. Recently a French meta-analysis of 13 random controlled trials questioned the central role of metformin in the care of patients with diabetes. In this meta-analysis, in which 9560 patients were given metformin and 3550 were given conventional treatment or placebo, metformin did not significantly affect the primary outcomes of all cause mortality or cardiovascular mortality. The secondary outcomes—myocardial infarction, stroke, heart failure, peripheral vascular disease, leg amputation, and microvascular complications—were also unaffected by treatment with metformin.’3

Today we have a virtually unquestioned model of diabetes that is very simple, and easy to understand. It should be simple to understand as it works like this. If the blood sugar goes up, the body produces insulin to lower it. If the blood sugar goes down, the body produces less insulin and the sugar level goes up.

This has meant that, if you find someone had high blood sugar levels, you basically hit them with insulin. I call insulin the ‘glucose hammer’ and, as a wise man once said. ‘If the only tool you have is a hammer, pretty soon everything starts to look like a nail’.

Reducing glucagon…. anybody?

There are many ways our medical system could save large amounts of funds without compromising health of citizens. Whether politicians and health officials are willing to make those changes, and the public accept, is to be seen.

I can think of several ways to lower medical costs. One that comes to mind is to be less aggressive in treating some growths as cancer. This study article is on thyroid tumors, but in the article is mention on many other similar growths that could be reclassified as non-cancer.

“Thyroid tumours are not always cancer, scientists say after groundbreaking study
“To my knowledge, this is the first time in the modern era a type of cancer is being reclassified as a non-cancer”, one researcher declared”

Particularly at budget-making time (Government Autumn Statement is coming up in November), it’s amazing how the NHS is always on the brink of collapse at such times.

Indeed yes! But I remember decades ago having an outpatient appointments and having to wait 8 hours as they block book everyone but heaven help you if you are late .

Nearly 3 years ago here in Ireland i shattered my wrist. A and E was fine but then came the outpatient clinics ans Lo! Block booking and waiting several hours for two minutes with a bored consultant. Same as the UK…

Indeed yes! But I remember decades ago having an outpatient appointments and having to wait 8 hours as they block book everyone but heaven help you if you are late .

Nearly 3 years ago here in Ireland i shattered my wrist. A and E was fine but then came the outpatient clinics ans Lo! Block booking and waiting several hours for two minutes with a bored consultant. Same as the UK…

Ah well!

A central problem in the UK is that the way the NHS is financed has led to a situation where the UK spends a lower percentage of GDP on health than similar countries, while being ‘free at the point of provision’ which has an impact on how patients are dealt with and outcomes.

The politics of NHS reform, however, make real change very difficult. The fact that there are successful alternative models in neighbouring countries is ignored and the immediate reaction to anybody suggesting change is that they want health care to be ‘like in the USA’ which means ‘immediate end of conversation’!

A central problem in the UK is that the way the NHS is financed has led to a situation where the UK spends a lower percentage of GDP on health than similar countries, while being ‘free at the point of provision’ which has an impact on how patients are dealt with and outcomes.

The politics of NHS reform, however, make real change very difficult. The fact that there are successful alternative models in neighbouring countries is ignored and the immediate reaction to anybody suggesting change is that they want health care to be ‘like in the USA’ which means ‘immediate end of conversation’!

So you are acknowledging the UK model isn’t the one to emulate, that’s news.

So you are acknowledging the UK model isn’t the one to emulate, that’s news.

In what sense news? What on earth do you mean by ‘acknowledging’? You have no idea about my views on health economics and I have never suggested the US should emulate anybody.

Which country has the right model?

If I were to choose, I would suggest a move to a SHI (Social/Statutory Health Insurance) system - as can be found in places like Germany, the Netherlands and Switzerland. Here’s the IEA (Institute of Economic Affairs) on the subject.